Smoking and health care costs: the pooled estimate remains uncertain
Smokers had higher estimated annual costs overall, but the pooled difference was not statistically significant and results varied greatly between studies.
Based on the published abstract. The full paper may contain additional methods, results and limitations.
The 30-second takeaway
The overall analysis did not establish a statistically significant difference in annual direct health care costs, despite a higher average estimate for smokers. Excluding studies involving chronic disease produced a significant association with higher costs. Substantial differences between studies remained, and these nonrandomized comparisons cannot establish that smoking caused the cost differences.
The studies produced highly inconsistent estimates. The overall confidence interval included both lower and higher costs for smokers, while the restricted analysis answered a narrower question and still showed substantial variation.
What researchers found
Mean difference in annual direct health care costs
Smokers versus nonsmokers, expressed in 2025 US dollars over 12 months. The pooled difference was not statistically significant.
What was measured
The review compared spending on direct health care rather than symptoms, survival or a treatment outcome. Researchers standardized the cost period and adjusted currency values so that estimates from different studies could be compared.
Why the analyses differ
Removing studies of chronic disease changed which populations contributed to the estimate. That analysis found higher costs among smokers, but it does not remove the uncertainty in the overall result or explain the remaining variation.
The original publication
Economic Burden of Self-Reported Tobacco Smoking Compared with Non-Smoking: Systematic Review and Meta-Analysis of Direct Health Care Costs.
Sweis NJ, Elfessi ZZ, Rubinstein I et al.
Adv Ther · 2025
- PubMed ID
- 40820188
- Record checked
AI-assisted research and writing. This explains one selected publication; it is not a complete review of everything known. Our approach.
One more question, understood.
Keep track of the research you’ve explored.